October 20, 2016

This years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th - 19th.  There was greater than 350 courses, labs, and workshops given throughout the week.  It was impossible to make all of these great lectures, but I was able to take away some very important clinical pearls that I wanted to share with our readers. 

August 1, 2016

Background: Procedural sedation and analgesia is a frequently performed procedure in the emergency department to help facilitate care of patients in an effective manner. Our goal should be to minimize pain and anxiety while minimizing adverse effects. We have discussed the complications associated with procedural sedation and analgesia on REBEL EM before HERE.  Ketamine and Propofol are two agents commonly used for this and each agent has its own theoretical advantages and disadvantages. Due to this, it has been hypothesized that the combination of the two agents may result in fewer adverse events because of each agent counteracting the disadvantages of the other. Despite this, to date, no RCTs have really shown a reduction in adverse events with the combination of propofol and ketamine.

May 23, 2016

The subclavian route is known to be the site for central line placement with the lowest risk of infection, but can also lead to many mechanical complications [2]. The biggest risk of subclavian line placement is an iatrogenic pneumothorax. The use of ultrasound for subclavian line placement can greatly reduce this risk by watching the needle enter the vein. But does arm position matter for ultrasound guided subclavian central lines?

April 7, 2016

Background: Peripheral venous cannulation is the most frequently performed procedure in the Emergency Department (ED). The vast majority of patients admitted to the hospital will leave the ED with an intravenous catheter (IV). While these devices typically have a “life-span” of 72 hours from placement, they often fail prematurely as a result of infection, phlebitis, occlusion or dislodgement. IV dislodgement is a particular bane to emergency providers and nurses because it often occurs during the patient’s ED stay requiring repeated cannulation and the associated expenditure of time and resources not to mention the additional pain/discomfort to the patient. Inadequate fixation of the catheter is a likely cause of dislodgement but may also contribute to infection and phlebitis due to small movements leading to microtrauma to the vein.

Medical-grade skin glue (cyanoacrylate) has been demonstrated to reduce peripheral arterial line failure rate in prior studies but has not been extensively studied for peripheral IV securing.

February 22, 2016

Background: As Emergency Department (ED) physicians it is not uncommon to give patients procedural sedation and analgesia (PSA) to help facilitate painful procedures. Performing PSA requires close monitoring and is not without potential adverse events. There are numerous analgesic, sedative, and anesthetic agents that can be used in combination for PSA in the ED. Adverse event reporting for PSA has been heterogeneous. The purpose of this systematic review and meta-analysis is to determine the incidence of adverse events during PSA in the ED, including the frequency of events with individual drugs and different drug combinations.